401k Plan data: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN plan

LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN
Plan identification number	001

LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LESLIE PEDERSEN LUNDT MD CHARTERED has sponsored the creation of one or more 401k plans.

Company Name: LESLIE PEDERSEN LUNDT MD CHARTERED

Employer identification number (EIN): 820450645

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 LESLIE PEDERSEN LUNDT MD
001 2016-01-01 LESLIE PEDERSEN LUNDT MD
001 2015-01-01 LESLIE PEDERSEN LUNDT MD
001 2014-01-01
001 2013-01-01
001 2012-01-01 LESLIE LUNDT
001 2011-01-01 LESLIE LUNDT
001 2010-01-01 LESLIE LUNDT
001 2009-01-01 LESLIE LUNDT LESLIE LUNDT 2010-06-10

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	LESLIE PEDERSEN LUNDT MD
001	2016-01-01	LESLIE PEDERSEN LUNDT MD
001	2015-01-01	LESLIE PEDERSEN LUNDT MD
001	2014-01-01
001	2013-01-01
001	2012-01-01	LESLIE LUNDT
001	2011-01-01	LESLIE LUNDT
001	2010-01-01	LESLIE LUNDT
001	2009-01-01	LESLIE LUNDT	LESLIE LUNDT	2010-06-10

Plan Statistics for LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN

Measure Date Value
2017: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 1
Number of participants with account balances 2016-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1
Total of all active and inactive participants 2014-01-01 1
Total participants 2014-01-01 1
Number of participants with account balances 2014-01-01 1
2013: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1
Total of all active and inactive participants 2013-01-01 1
Total participants 2013-01-01 1
Number of participants with account balances 2013-01-01 1
2012: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
Total of all active and inactive participants 2012-01-01 1
Total participants 2012-01-01 1
Number of participants with account balances 2012-01-01 1
2011: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
Total of all active and inactive participants 2011-01-01 1
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
2010: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1
Total of all active and inactive participants 2010-01-01 1
Total participants 2010-01-01 1
Number of participants with account balances 2010-01-01 1
2009: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1
Total of all active and inactive participants 2009-01-01 1
Total participants 2009-01-01 1
Number of participants with account balances 2009-01-01 1

Measure	Date	Value
2017: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1
Number of participants with account balances	2016-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1
Total of all active and inactive participants	2014-01-01	1
Total participants	2014-01-01	1
Number of participants with account balances	2014-01-01	1
2013: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1
Total of all active and inactive participants	2013-01-01	1
Total participants	2013-01-01	1
Number of participants with account balances	2013-01-01	1
2012: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
Total of all active and inactive participants	2012-01-01	1
Total participants	2012-01-01	1
Number of participants with account balances	2012-01-01	1
2011: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
Total of all active and inactive participants	2011-01-01	1
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
2010: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1
Total of all active and inactive participants	2010-01-01	1
Total participants	2010-01-01	1
Number of participants with account balances	2010-01-01	1
2009: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1
Total of all active and inactive participants	2009-01-01	1
Total participants	2009-01-01	1
Number of participants with account balances	2009-01-01	1

Financial Data on LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2017 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$83,444
Expenses. Total of all expenses incurred	2017-12-31	$777,772
Benefits paid (including direct rollovers)	2017-12-31	$777,751
Total plan assets at end of year	2017-12-31	$0
Total plan assets at beginning of year	2017-12-31	$694,328
Value of fidelity bond covering the plan	2017-12-31	$70,000
Other income received	2017-12-31	$83,444
Net income (gross income less expenses)	2017-12-31	$-694,328
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$694,328
Assets. Value of participant loans	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$21
2016 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$65,338
Expenses. Total of all expenses incurred	2016-12-31	$25
Total plan assets at end of year	2016-12-31	$694,328
Total plan assets at beginning of year	2016-12-31	$629,015
Value of fidelity bond covering the plan	2016-12-31	$70,000
Other income received	2016-12-31	$65,338
Net income (gross income less expenses)	2016-12-31	$65,313
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$694,328
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$629,015
Assets. Value of participant loans	2016-12-31	$11,372
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$25
2015 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-746
Expenses. Total of all expenses incurred	2015-12-31	$25
Total plan assets at end of year	2015-12-31	$629,015
Total plan assets at beginning of year	2015-12-31	$629,786
Value of fidelity bond covering the plan	2015-12-31	$63,000
Other income received	2015-12-31	$-2,746
Net income (gross income less expenses)	2015-12-31	$-771
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$629,015
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$629,786
Assets. Value of participant loans	2015-12-31	$21,643
Total contributions received or receivable from employer(s)	2015-12-31	$2,000
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$25
2014 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$45,920
Expenses. Total of all expenses incurred	2014-12-31	$25
Total plan assets at end of year	2014-12-31	$629,786
Total plan assets at beginning of year	2014-12-31	$583,891
Value of fidelity bond covering the plan	2014-12-31	$25,000
Other income received	2014-12-31	$45,920
Net income (gross income less expenses)	2014-12-31	$45,895
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$629,786
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$583,891
Assets. Value of participant loans	2014-12-31	$31,611
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$25
2013 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$-41,909
Expenses. Total of all expenses incurred	2013-12-31	$25
Total plan assets at end of year	2013-12-31	$583,891
Total plan assets at beginning of year	2013-12-31	$625,825
Value of fidelity bond covering the plan	2013-12-31	$25,000
Total contributions received or receivable from participants	2013-12-31	$0
Other income received	2013-12-31	$-41,909
Net income (gross income less expenses)	2013-12-31	$-41,934
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$583,891
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$625,825
Assets. Value of participant loans	2013-12-31	$41,294
Total contributions received or receivable from employer(s)	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$25
2012 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$69,739
Total plan assets at end of year	2012-12-31	$625,825
Total plan assets at beginning of year	2012-12-31	$556,086
Value of fidelity bond covering the plan	2012-12-31	$25,000
Total contributions received or receivable from participants	2012-12-31	$22,500
Other income received	2012-12-31	$14,739
Net income (gross income less expenses)	2012-12-31	$69,739
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$625,825
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$556,086
Total contributions received or receivable from employer(s)	2012-12-31	$32,500
2011 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$14,779
Total plan assets at end of year	2011-12-31	$556,086
Total plan assets at beginning of year	2011-12-31	$541,307
Value of fidelity bond covering the plan	2011-12-31	$25,000
Total contributions received or receivable from participants	2011-12-31	$22,000
Other income received	2011-12-31	$-39,721
Net income (gross income less expenses)	2011-12-31	$14,779
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$556,086
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$541,307
Total contributions received or receivable from employer(s)	2011-12-31	$32,500
2010 : LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$148,327
Total plan assets at end of year	2010-12-31	$541,307
Total plan assets at beginning of year	2010-12-31	$392,980
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$22,000
Other income received	2010-12-31	$98,827
Net income (gross income less expenses)	2010-12-31	$148,327
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$541,307
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$392,980
Total contributions received or receivable from employer(s)	2010-12-31	$27,500

Form 5500 Responses for LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN

2017: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: LESLIE R. PEDERSEN, M.D., CHARTERED 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	LESLIE PEDERSEN LUNDT MD CHARTERED
Employer identification number (EIN):	820450645
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists